Preparation for Bariatric Surgery

What are the routine tests before surgery?
Certain basic tests are done prior to bariatric surgery: a Complete Blood Count (CBC), Urinalysis, and a Chemistry Panel, which gives a readout of about 20 blood chemistry values. All patients get a chest X-ray and an electrocardiogram. Many surgeons ask for a gallbladder ultrasound to look for gallstones. Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, cardiology evaluation, or psychiatric evaluation, may be requested when indicated.

What is the purpose of all these tests?
An accurate assessment of your health is needed before bariatric surgery. The best way to avoid complications is to never have them in the first place. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery increases cardiac stress, your heart will be thoroughly evaluated. These tests will determine if you have liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in body fluids, or abnormal blood fat levels.

Why do I have to have a GI Evaluation?
Patients who have significant gastrointestinal symptoms such as upper abdominal pain, heartburn, belching sour fluid, etc., may have underlying problems such as a hiatal hernia, gastroesophageal reflux or peptic ulcer. For example, many patients have symptoms of reflux. Up to 15 percentĀ of these patients may show early changes in the lining of the esophagus, which could predispose them to cancer of the esophagus. It is important to identify these changes so a suitable surveillance or treatment program can be planned.

Why do I have to have a sleep study?
The sleep study detects a tendency for abnormal stopping of breathing, usually associated with airway blockage when the muscles relax during sleep. This condition is associated with a high mortality rate. After surgery, you will be sedated and will receive narcotics for pain, which further depress normal breathing and reflexes. Airway blockage becomes more dangerous at this time. It is important to have a clear picture of what to expect and how to handle it.

Why do I have to have a psychological evaluation?
The most common reason a psychological evaluation is ordered is that your insurance company may require it. Most psychologists will evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic recovery plan.

What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?
Medical problems, such as heart or lung problems, can increase the risk of any surgery. On the other hand, if they are problems related to the patient's weight, they also increase the need for surgery. Medical problems may not dissuade the surgeon from recommending gastric bypass surgery if it is otherwise appropriate, but those conditions will make a patient's risk higher than average.

If I want to undergo a gastric bypass, how long do I have to wait?
New consultation appointments can be scheduled within a few weeks. After appropriate forms are completed and mailed to your insurance company it may take up to 30 to 45 days to receive an approval. Your pre-operative testing and surgery will be scheduled after approval is received.

What can I do before the appointment to speed up the process of getting ready for surgery?

  • Select a primary care physician if you don't already have one, and establish a relationship with him or her. Work with your physician to ensure that your routine health maintenance testing is current. Discuss diet and exercise plans you have tried. Some insurance companies require documentation of previous diet attempts by a physician.
  • Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
  • Bring any pertinent medical data to your appointment with the surgeon, including reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
  • Bring a list of your medications with dose and schedule.
  • Stop smoking. Surgical patients who use tobacco products are at a higher surgical risk.